Healthcare Provider Details

I. General information

NPI: 1659927341
Provider Name (Legal Business Name): PEARL HUANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2019
Last Update Date: 08/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19304 HORACE HARDING EXPY APT 2F
FRESH MEADOWS NY
11365-2820
US

IV. Provider business mailing address

6815 LITTLE NECK PKWY
GLEN OAKS NY
11004-1002
US

V. Phone/Fax

Practice location:
  • Phone: 718-276-7935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF309247
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: